Along with the prohibition of Variolous Inoculation in 1840, Parliament passed an Act for the provision of Vaccination out of the poor-rate. A scheme had been formulated and petitioned for by the Provincial Medical and Surgical Association in 1838, with the expectation that the Government might be induced to create a multitude of places for “regularly educated vaccinators, with suitable salaries, in districts sufficiently numerous to embrace the whole of the poor population of the country.” The House of Commons being of a thrifty turn in those days, did not however favour such a magnificent development of place and pay under the National Vaccine Establishment, and disposed of the project by referring the provision of vaccination to the parochial authorities, who might be trusted to do what was needful with due regard to economy. In every union, and in every parish that was not in union, it was provided that there should be one or more medical practitioners appointed by the Guardians for the gratuitous vaccination of the inhabitants, with remuneration from the rates according to the number operated upon.[278] This accession to their burdens met with anything but welcome from the ratepayers in general. Contracts for vaccination at so much per head were submitted for competition, and those who accepted the rite at the public expense were spoken of as paupers, and in some places had their names published to “shame them.” To remove the stigma of pauperism from the parish prophylaxy, an Act was passed in 1841 in which it was declared that public vaccination was not of the nature of “parochial relief, alms, or charitable allowance,” and did not therefore deprive the recipient of any “right or privilege,” or subject him “to any disability or disqualification whatsoever.”[279]
The reports of the National Vaccine Establishment from 1841 to 1850 continued to be of the same perfunctory character. They usually started with a profession of confidence in vaccination, after the fashion of Mrs. Micawber’s resolution never to desert Micawber; the signature to which declaration by the President and Senior Censor of the Royal College of Physicians, and the President of the Royal College of Surgeons being accompanied with a douceur of £100 to each. For example, we read—
1841.—Smallpox has prevailed epidemically with considerable severity since our last Report; but we do not abate an iota of our confidence in Vaccination as the best protective against its malignant influence.
1845.—The unabated confidence with which we continue to regard Vaccination, etc., etc.
1847.—Nothing has occurred to diminish our confidence in the protective influence of Vaccination. It is true that Smallpox has now and then reappeared; and lately to an extent which has called for additional efforts on the part of all the officers of the Establishment; but we regard such recurrence as due to the ordinary operations of those periodical influences which give to the disease its epidemic character; and in some localities, as in Ireland, to that distress with which contagious diseases are so invariably associated.
The reporters apparently forgot that according to the doctrine of which they were the representatives, vaccination excluded the possibility of smallpox under whatever circumstances of atmosphere, filth, or privation. If only effective in the absence of the ordinary conditions of smallpox, wherein consisted the benefit of the rite?
Ceely of Aylesbury in 1839, and Badcock of Brighton in 1840, succeeded in inoculating cows with smallpox, and the resulting virus was described as cowpox, and used for vaccination far and wide. Apparently the procedure was not approved by the Vaccine Establishment, for we read in the report—
1841.—The matter we employ is obtained by succession from the original virus communicated by Dr. Jenner himself, and that we find is as effectual as ever. We may be excused therefore, we hope, if we discourage an incautious dissemination of matter obtained from new sources, which has not stood the test of ample experience.
The original virus communicated by Jenner himself! What was it? When the National Vaccine Establishment was instituted in 1808, the virus in circulation in London was accepted as stock, and it certainly had several origins. It was cowpox as discovered by Pearson; it was horsegrease cowpox and horsepox as derived from Jenner; and there is reason to believe it was smallpox from Woodville and others. The claim, therefore, to the possession of a specific variety of matter communicated by Jenner was fictitious.
Again, through the recurrent failure of vaccination to avert smallpox, the Board had to discountenance the assertion that their virus had lost its virtue through prolonged transmission—a reason which led some to prefer the fresh variolous stocks of Ceely and Badcock—
1840.—The experience of another year has afforded proofs of the propriety, in the present state of our knowledge, of preferring Vaccine Matter, the produce of the original virus furnished by Dr. Jenner, which has now passed happily through successive generations of subjects in the course of 43 years, and which forms the principal source of our supply, to any which may have been recently taken from the cow.
Here we have “the original virus furnished by Dr. Jenner” set forth as no more than “the principal source of supply.” The reports are characterised by many similar inconsistencies—
1845.—We regard as erroneous the belief that Vaccine Virus undergoes deterioration by being kept; in proof of which we are prepared to establish, by unquestionable documents, the striking fact, that Lymph which had been conveyed to and from India has retained its protective properties wholly unimpaired after a lapse of 20 years.
Another vexation of the Board was due to the assertion that the protective virtues of vaccination gradually wore out, and that the repetition of the rite was necessary for the maintenance of salvation. In the London Medical Gazette, 2nd August, 1844, it was proclaimed—
We are sorry to announce the extensive prevalence of Smallpox at this time among us. Revaccinate, Revaccinate, say we.
Such advice was essentially heretical and damnable; for Jenner affirmed and maintained—
That the human frame, when once it has felt the influence of the genuine Cowpox, is never afterwards, at any period of its existence, assailable by Smallpox.
If revaccination were possible, smallpox after vaccination was possible; and if so much were conceded, on what ground was vaccination to be defended? Whatever the facts, the members of the Board resolved to stand loyally by the primitive Jennerian doctrine, and in their Report for 1851 thus testified—
It may be expedient to remind the public of the established fact which the Board upon former occasions anxiously insisted upon, that the restriction of the protective power of Vaccination to any age, or to any term of years, is an hypothesis contradicted by experience, and wholly unsupported by analogy.
Notwithstanding the prohibition of Variolous Inoculation, the Board had repeatedly to deplore its continuance especially in Ireland. Thus we read—
1850.—The Board again entreat the attention of the Government to the fact that Inoculation for the Smallpox still continues; and that the disease is communicated by vagrants to those unprotected by Vaccination in town and country. The contagion is carried throughout the land by wandering Irish, and no care, however great, can be successful in eradicating Smallpox, whilst the neglect of Vaccination and the practice of Variolous Inoculation are permitted in Ireland.
It was Jenner’s practice to attribute to wilful blindness and innate depravity any scepticism as to the efficacy of vaccination; and throughout the Reports of the Establishment this habit of imputation was maintained. Vaccination was treated as a sort of divine revelation, plenary and manifest, which could only be disputed or resisted from deliberate perversity, or, more charitably, from abject dulness or ignorance; and it would be easy to construct a catena of piquant deliverances under this semi-theological persuasion. Such observations as the following were of the order of matter-of-course—
1850.—We regret to learn that in our own country the spread of Vaccination is still materially impeded by influences emanating from ignorance and prejudice in the lower orders, and from prejudices in many who cannot plead the excuse of ignorance.
1851.—It is lamentable to observe not only the indifference, but the active hostility displayed by the community to Vaccination. Deeply-rooted prejudices and absurd superstitions are ever opposing its adoption.
The Reports of the Establishment year after year displayed in full measure the familiar complacency of official routine—where pay is constant and wheels propelled from office desks revolve smoothly in space—so many Londoners vaccinated, so many charges of virus distributed, and confidence in the sacred prophylactic unabated. A revolution was, however, impending. The attitude of the public mind toward disease had become transformed. Faith in sanitation as a preventive of fevers had been created, and a popular demand for sanitary improvement had set in. Under cover of this new enthusiasm some of the shrewder advocates of vaccination conjectured that it would be possible to effect its endowment and establishment on a scale hitherto unattempted in England. It was true that vaccination had no relation to sanitation; but the reforming and philanthropic mob were madly in favour of whatever bore the promise of health, and were not likely to show themselves hypercritical or obstructive.
The first movement toward a new advance is discernible in the Report of the Establishment for 1850 wherein we read—
The Board have had to solicit the attention of Her Majesty’s Government on several occasions to the deplorable fact that a very large proportion of the children of the poorer classes in the Metropolis, and in England and Wales generally, but above all in Ireland, remain year by year without the benefit of Vaccination. Their testimony on this important part of the sanitary condition of the population has been derived from the reports of numerous competent medical witnesses in all parts of the United Kingdom, and from the frequent recurrence of rapid and fatal invasions of Smallpox, to which their attention has been repeatedly called by urgent applications for Vaccine Lymph. It is satisfactory to find that the representations which the Board have made are most unequivocally confirmed by the report of Mr. Grainger, from which it appears that the number of persons under one year who were vaccinated during the year ended 29th September, 1848, in 627 Unions of parishes in England and Wales (exclusive of those vaccinated at the cost of their parents) amounted to no more than 33 per cent., compared with the total number of births registered in the same period.
These figures are worth noting. Dating from 1840, an effort was made to overtake the vaccination of the people by the agency of the poor law; and yet so late as 1848, not more than one-third of the children born were accounted for as Jennerised. Adding to this third the offspring of the upper and middle classes, we may safely conclude that up to 1850 not half the inhabitants of England and Wales were vaccinated; and the unvaccinated half included the lower classes most subject to smallpox—victims of that “distress with which contagious diseases are so invariably associated,” to cite the words of the Report for 1847. The point is especially worth noting because the decline of smallpox, which set in last century, is continually ascribed to vaccination. A true cause however must be commensurate with the effect; and yet here we see the asserted cause of the fall in smallpox did not apply in 1848 to half the English people; in which half, moreover, lay nine-tenths of the field in which smallpox was possible. The Report for 1850 continues—
The Board lament that they have no means of adopting or enforcing such measures as are obviously necessary for the prevention of Smallpox. They have no power of instituting domiciliary visits, or house to house visitation; and indeed hitherto such have been deemed too much of an encroachment on the liberty of the subject. They have no power to punish officially the practice of illegal Inoculation, or the exposure of infected persons; and they have only had the means granted to them of prosecuting such offenders in two cases, in order to establish the fact of the illegality of Variolous Inoculation. They can only recommend and aid, but they cannot enforce Vaccination.
The progress of Vaccination is more rapid in Foreign Countries where municipal measures or legislative enactments are adopted to promote its dissemination; and they beg to express their conviction that if England is to be free from Smallpox, the interposition of the Legislature alone, by wise and comprehensive measures, can disarm the Pestilence of its terrors, and realise the fond hopes and prayers of the Friends of Humanity for its extinction.
In these observations is revealed the movement of a new spirit—of a revived resolution to obtain for vaccination the force of law. Similar projects had from time to time been advanced by enthusiasts, and swept aside by statesmen. Canning, for instance, had declared that he could not imagine any circumstances whatever that would induce him to consent to the compulsory infliction of vaccination; and, at a later date, Sir Robert Peel expressed himself to like effect, saying, “To make vaccination compulsory, as in some despotic countries, would be so opposite to the mental habits of the British people, and the freedom of opinion wherein they rightly glory, that I never could be a party to such compulsion.”[280] But Peel died in 1850, and a strong public opinion in favour of sanitary reform had come into existence without much scruple as to methods. Diseases, hitherto regarded as supernatural inflictions, were traced to conditions of life, remediable or avertible; so that the submission and terror which sickness formerly inspired gave place to widely different sentiments—a temper of intolerance with illness, and a determination to extirpate its infectious forms with those who in ignorance or wilfulness should persist in their generation and diffusion.